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Saada M, Kobo O, Polad J, Halabi M, IJsselmuiden AJJ, Puentes Á, Monségu J, Austin D, Baisebenov RK, Spanó F, Roguin A. Prognosis of PCI in AMI setting in the elderly population: Outcomes from the multicenter prospective e-ULTIMASTER registry. Clin Cardiol 2022; 45:1211-1219. [PMID: 36072999 DOI: 10.1002/clc.23902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Elderly patients with ST-elevation myocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI) are usually excluded from major trials. HYOPTHESIS This study sought to assess 1-year clinical outcomes following PCI with a drug-eluting stent in patients older than 80 years old with STEMI. METHODS The large all-comer, multicontinental e-ULTIMASTER registry included 7507 patients with STEMI who underwent PCI using the Ultimaster stent. The primary clinical endpoint was 1-year target lesion failure, a composite of cardiac death (CD), target vessel-related myocardial infarction (TV-MI), or clinically driven target lesion revascularization (CD-TLR). RESULTS There were 457 (6.1%) patients in the elderly group (≥80 years old) that were compared to 7050 (93.9%) patients <80 years. The elderly patients included more female patients and had significantly more comorbidities and had more complex coronary anatomy. The primary endpoint occurred in 7.2% of the elderly, compared to 3.1% of the younger group (p < .001). All-cause mortality was significantly higher among the elderly group compared to the younger group (10.1% vs. 2.3%, p < .0001), as well as CD (6.1% vs. 1.6%, p < .0001), but not TV-MI (1.1% vs. 0.7%, p = .34) or CD-TLR (1.1% vs. 1.4%, p = .63). CONCLUSION Elderly patients with STEMI presentation had a higher incidence of the composite endpoint than younger patients. All-cause and CD were higher for elderly patients compared to patients younger than 80 years old. However, there was no difference in the incidence of TV-MI or target lesion revascularizations. These findings suggest that PCI for STEMI in elderly patients is relatively safe.
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Affiliation(s)
- Majdi Saada
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Jawed Polad
- Department of Cardiology, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands
| | - Majdi Halabi
- Department of Cardiology, Ziv Hospital, Safed, Israel
| | | | - Ángel Puentes
- Department of Cardiology, San Juan de Dios Hospital, Santiago, Chile
| | - Jacques Monségu
- Department of Cardiology, Groupe Hospitalier Mutualiste, Institut Cardiovasculaire, Grenoble, France
| | - David Austin
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | | | - Fabrizio Spanó
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
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Giacaman A, Assef V, Ramirez P, Puentes Á, Perez O, Olmos A, Perez L, Venegas R, Pincetti C, Vergara MJ, Antezana G, Cavada G, García-García HM, Maluenda G. PRospective Observational Registry Evaluating the Safety and Effectivenessof Orsiro Stent in Chilean Patients - ROSES Registry. Cardiovasc Revasc Med 2022; 36:65-70. [PMID: 34092499 DOI: 10.1016/j.carrev.2021.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is little information on the performance of the new generation of stents with bioabsorbable polymers in the Latin American population. This registry aimed to further validate the safety and efficacy of the Orsiro bioresorbable-polymer sirolimus-eluting stent (BPSES) in unselected patients undergoing percutaneous coronary intervention (PCI) in Chilean centers. METHODS We prospectively enrolled patients undergoing PCI with BPSES in 6 Chilean centers. The primary endpoint was defined as the composite of cardiac death, target vessel-related myocardial infarction (MI), and clinically driven target lesion revascularization at 1-year follow-up. RESULTS From April 2017 to February 2019, 520 patients were enrolled in the registry, more frequently male (74.6%), with a mean age of 62.7 ± 10.8 years and a high prevalence of diabetes (40.2%). The clinical presentation was stable angina in 41.1% (n = 214), acute MI in 52.5% (n = 167 [32.1%] ST-elevation MI and n = 106 [20.4%] non-ST-elevation MI), and unstable angina in 6.3% (n = 33). Of 610 treated lesions, 425 (69.7%) were American College of Cardiology/American Heart Association type B or C lesions. Device and procedural success were achieved in 99.4% and 98.7% of the patients, respectively. The primary endpoint of the study occurred in 4%, primarily driven by cardiac death. CONCLUSIONS The results of the ROSES multicenter registry indicated good clinical outcomes of BPSES Orsiro in all-comers Latin Americann patients undergoing PCI, despite the high-risk patients and treated lesions.
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Affiliation(s)
- Arturo Giacaman
- San Borja Arriarán Hospital & University of Chile, Santiago, Chile
| | - Víctor Assef
- Puerto Montt Regional Hospital, Puerto Montt, Chile
| | | | | | | | | | - Luis Perez
- Guillermo Grant Benavente Hospital & University of Concepción, Concepción, Chile
| | - Reinaldo Venegas
- Guillermo Grant Benavente Hospital & University of Concepción, Concepción, Chile
| | | | | | - Gonzalo Antezana
- San Borja Arriarán Hospital & University of Chile, Santiago, Chile
| | - Gabriel Cavada
- San Borja Arriarán Hospital & University of Chile, Santiago, Chile
| | | | - Gabriel Maluenda
- San Borja Arriarán Hospital & University of Chile, Santiago, Chile.
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Rodrigo R, Prieto JC, Aguayo R, Ramos C, Puentes Á, Gajardo A, Panieri E, Rojas-Solé C, Lillo-Moya J, Saso L. Joint Cardioprotective Effect of Vitamin C and Other Antioxidants against Reperfusion Injury in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention. Molecules 2021; 26:molecules26185702. [PMID: 34577176 PMCID: PMC8468345 DOI: 10.3390/molecules26185702] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Abstract
Percutaneous coronary intervention (PCI) has long remained the gold standard therapy to restore coronary blood flow after acute myocardial infarction (AMI). However, this procedure leads to the development of increased production of reactive oxygen species (ROS) that can exacerbate the damage caused by AMI, particularly during the reperfusion phase. Numerous attempts based on antioxidant treatments, aimed to reduce the oxidative injury of cardiac tissue, have failed in achieving an effective therapy for these patients. Among these studies, results derived from the use of vitamin C (Vit C) have been inconclusive so far, likely due to suboptimal study designs, misinterpretations, and the erroneous conclusions of clinical trials. Nevertheless, recent clinical trials have shown that the intravenous infusion of Vit C prior to PCI-reduced cardiac injury biomarkers, as well as inflammatory biomarkers and ROS production. In addition, improvements of functional parameters, such as left ventricular ejection fraction (LVEF) and telediastolic left ventricular volume, showed a trend but had an inconclusive association with Vit C. Therefore, it seems reasonable that these beneficial effects could be further enhanced by the association with other antioxidant agents. Indeed, the complexity and the multifactorial nature of the mechanism of injury occurring in AMI demands multitarget agents to reach an enhancement of the expected cardioprotection, a paradigm needing to be demonstrated. The present review provides data supporting the view that an intravenous infusion containing combined safe antioxidants could be a suitable strategy to reduce cardiac injury, thus improving the clinical outcome, life quality, and life expectancy of patients subjected to PCI following AMI.
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Affiliation(s)
- Ramón Rodrigo
- Molecular and Clinical Pharmacology Program, Faculty of Medicine, Campus Norte, Institute of Biomedical Sciences, University of Chile, Avda. Independencia 1027, Santiago 8380000, Chile; (J.C.P.); (C.R.-S.); (J.L.-M.)
- Correspondence:
| | - Juan Carlos Prieto
- Molecular and Clinical Pharmacology Program, Faculty of Medicine, Campus Norte, Institute of Biomedical Sciences, University of Chile, Avda. Independencia 1027, Santiago 8380000, Chile; (J.C.P.); (C.R.-S.); (J.L.-M.)
- University of Chile Clinical Hospital, Campus Norte, Carlos Lorca Tobar 999, Independencia, Santiago 8380456, Chile; (C.R.); (A.G.)
| | - Rubén Aguayo
- Cardiology Unit, Department of Medicine, Occident Division, San Juan de Dios Hospital, Avenida Portales 3239, Santiago 8500000, Chile; (R.A.); (Á.P.)
| | - Cristóbal Ramos
- University of Chile Clinical Hospital, Campus Norte, Carlos Lorca Tobar 999, Independencia, Santiago 8380456, Chile; (C.R.); (A.G.)
| | - Ángel Puentes
- Cardiology Unit, Department of Medicine, Occident Division, San Juan de Dios Hospital, Avenida Portales 3239, Santiago 8500000, Chile; (R.A.); (Á.P.)
| | - Abraham Gajardo
- University of Chile Clinical Hospital, Campus Norte, Carlos Lorca Tobar 999, Independencia, Santiago 8380456, Chile; (C.R.); (A.G.)
| | - Emiliano Panieri
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Faculty of Pharmacy and Medicine, Sapienza University, P.le Aldo Moro 5, 00185 Rome, Italy; (E.P.); (L.S.)
| | - Catalina Rojas-Solé
- Molecular and Clinical Pharmacology Program, Faculty of Medicine, Campus Norte, Institute of Biomedical Sciences, University of Chile, Avda. Independencia 1027, Santiago 8380000, Chile; (J.C.P.); (C.R.-S.); (J.L.-M.)
| | - José Lillo-Moya
- Molecular and Clinical Pharmacology Program, Faculty of Medicine, Campus Norte, Institute of Biomedical Sciences, University of Chile, Avda. Independencia 1027, Santiago 8380000, Chile; (J.C.P.); (C.R.-S.); (J.L.-M.)
| | - Luciano Saso
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Faculty of Pharmacy and Medicine, Sapienza University, P.le Aldo Moro 5, 00185 Rome, Italy; (E.P.); (L.S.)
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Armijo G, Puentes Á, Ceballos A, Quezada M, Tamayo C, Donoso H, Ramírez P, Backhouse C, Nombela-Franco L. [Percutaneous implantation of an aortic prosthetic valve on a degenerated mitral bioprosthesis. Report of one case]. Rev Med Chil 2021; 149:137-141. [PMID: 34106146 DOI: 10.4067/s0034-98872021000100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022]
Abstract
Reintervention of a mitral degenerated bioprosthesis has a high surgical risk, especially in elderly patients with multiple comorbidities. We report a 74 years old female with two previous cardiac surgical procedures and a new structural mitral bioprosthesis deterioration with severe mitral regurgitation. Considering her high-surgical risk, a fully percutaneous treatment was performed with a balloon-expandable aortic valve in mitral position (valve-in-valve) through a transseptal approach with a favorable outcome. This technique is an attractive and effective option with a relatively low rate of complications that could solve this challenging and complex disease.
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Affiliation(s)
- Germán Armijo
- Centro de Enfermedades Cardiovasculares, Hospital San Juan de Dios, Santiago, Chile
| | - Ángel Puentes
- Centro de Enfermedades Cardiovasculares, Hospital San Juan de Dios, Santiago, Chile
| | - Alejandro Ceballos
- Centro de Enfermedades Cardiovasculares, Hospital San Juan de Dios, Santiago, Chile
| | - Mauricio Quezada
- Centro de Enfermedades Cardiovasculares, Hospital San Juan de Dios, Santiago, Chile
| | - Carlos Tamayo
- Centro de Enfermedades Cardiovasculares, Hospital San Juan de Dios, Santiago, Chile
| | - Hernán Donoso
- Centro de Enfermedades Cardiovasculares, Hospital San Juan de Dios, Santiago, Chile
| | - Pablo Ramírez
- Centro de Enfermedades Cardiovasculares, Hospital San Juan de Dios, Santiago, Chile
| | - Christian Backhouse
- Centro de Enfermedades Cardiovasculares, Hospital San Juan de Dios, Santiago, Chile
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Oporto JI, Zúñiga P, Ossandón D, Zanolli M, Pérez V, López JP, Stetcher X, Rodríguez A, Puentes Á, Rustom S, Lobos J. Intra-arterial chemotherapy for retinoblastoma treatment in Chile: Experience and results 2013-2020. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96:288-292. [PMID: 34092282 DOI: 10.1016/j.oftale.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish the success rate of salvage intra-arterial chemotherapy (IAC), defined as the percentage of eyes that achieved tumoral remission and avoided enucleation. The second objective was the clinical characterization, catheterization results, and associated local and systemic complications. METHODS Retrospective, interventional case series of 29 patients (35 eyes) with persistent or recurrent retinoblastoma. RESULTS A total of 73 salvage IAC procedures with topotecan and melphalan were carried out. Success rate was 77% at a mean follow-up of 41.4 months. All patients with only one remaining eye avoided enucleation (10 cases). Catheterization was successful in 98.6% of cases. The types of catheterizations were as follows: 71.2% supraselective ophthalmic artery, 12.3% occlusion pump assisted supraselective ophthalmic artery, 16.4% selective external carotid with retrograde flow. 14% of patients suffered local adverse effects: 1 (2.8%) transitory ptosis, 1 (2.8%) transitory oculomotor nerve palsy, 2 (5.7%) aseptic cellulitis and 1 (2.8%) periorbitary pigmentation. 4.1% (3 cases) suffered neutropenia due to medullar chemosuppression. There were no cases of severe anemia or thrombocytopenia. There were no cerebral ischemic events or mortality associated to the procedure. CONCLUSION IAC with melphalan and topotecan is a safe and effective treatment option for persistent or recurrent retinoblastoma, able to reduce enucleation rates.
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Affiliation(s)
- J I Oporto
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Zúñiga
- Clínica Alemana de Santiago-Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - D Ossandón
- Clínica Alemana de Santiago-Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; Hospital de San Juan de Dios, Santiago, Chile.
| | - M Zanolli
- Clínica Alemana de Santiago-Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - V Pérez
- Clínica Alemana de Santiago-Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; Hospital de San Juan de Dios, Santiago, Chile
| | - J P López
- Clínica Alemana de Santiago-Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - X Stetcher
- Clínica Alemana de Santiago-Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - A Rodríguez
- Hospital de San Juan de Dios, Santiago, Chile
| | - Á Puentes
- Hospital de San Juan de Dios, Santiago, Chile
| | - S Rustom
- Hospital de San Juan de Dios, Santiago, Chile
| | - J Lobos
- Hospital de San Juan de Dios, Santiago, Chile
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Sepúlveda P, Ortega J, Armijo G, Torres J, Ramírez P, Backhouse C, Vargas C, López L, González F, Puentes Á, Donoso H, Bellet A, Godoy D, Araya M, Andrade CL, Molina JP, Nazzal C. [Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension]. Rev Med Chil 2019; 147:426-436. [PMID: 31344203 DOI: 10.4067/s0034-98872019000400426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/18/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) is a therapeutic alternative for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). AIM To report the initial experience with the "refined BPA technique" with the use of intravascular images. PATIENTS AND METHODS Between June 2015 and June 2016 we selected fourteen patients with CTEPH who were considered candidates for BPA. Lesions targeted for treatment were further analyzed using intravascular imaging with optical frequency domain imaging (OFDI). We report the immediate hemodynamic results and four weeks of follow-up of the first eight patients of this series. RESULTS We performed 16 BPA in eight patients aged 61 ± 14 years (88% women). Mean pulmonary artery pressure (PAPm) was 48.6 ± 5.8 mmHg. Success was achieved in seven patients (88%). A mean of 2.3 segments per patient were intervened in 11 sessions (1.6 sessions/ patient). Only one patient developed lung reperfusion injury. No mortality was associated with the procedure. After the last BPA session, PAPm decreased to 37.4 ± 8.6 mmHg (p=0.02). Pulmonary vascular resistance (RVP) decreased from 858,6 ± 377,0 at baseline to 516,6 ± 323,3 Dynes/sec/cm-5 (p<0.01) and the cardiac index increased from 2.4±0.6 at baseline to 2.8±0.3 L/min/m2 (p=0.01). At 4 weeks after the last BPA, WHO functional class improved from 3.3±0.5 to 2.5±0.5 (p<0,01) and six minutes walking distance from 331±92 to 451±149 m (p=0.01). CONCLUSIONS BPA guided by OFDI for the treatment of inoperable CTEPH patients is a safe alternative with excellent immediate hemodynamic and clinical results.
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Affiliation(s)
- Pablo Sepúlveda
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - Juan Ortega
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - German Armijo
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - José Torres
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - Pablo Ramírez
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - Christian Backhouse
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - César Vargas
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - Leonel López
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - Felipe González
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - Ángel Puentes
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - Hernán Donoso
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - Augusto Bellet
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - Diego Godoy
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | - Mario Araya
- Unidad de Cardiología, Laboratorio de Hemodinamia, Hospital San Juan de Dios, Santiago, Chile
| | | | - Juan Pablo Molina
- Centro Diagnóstico y Terapéutico, Hospital San Juan de Dios, Santiago, Chile
| | - Carolina Nazzal
- Escuela de Salud Pública, Universidad de Chile, Santiago, Chile
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Ramos C, Brito R, González-Montero J, Valls N, Gormaz JG, Prieto JC, Aguayo R, Puentes Á, Noriega V, Pereira G, Palavecino T, Rodrigo R. Effects of a novel ascorbate-based protocol on infarct size and ventricle function in acute myocardial infarction patients undergoing percutaneous coronary angioplasty. Arch Med Sci 2017; 13:558-567. [PMID: 28507569 PMCID: PMC5420620 DOI: 10.5114/aoms.2016.59713] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/15/2016] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION This study was designed to test the hypothesis that high-dose ascorbate prior to reperfusion followed by low chronic oral doses ameliorate myocardial reperfusion injury (MRI) in acute myocardial infarction patients subjected to primary percutaneous coronary angioplasty (PCA). MATERIAL AND METHODS A randomized double-blind placebo-controlled and multicenter clinical trial was performed on acute myocardial infarction (AMI) patients who underwent PCA. Sodium ascorbate (320 mmol/l, n = 53) or placebo (n = 46) was infused 30 min prior to PCA. Blood samples were drawn at enrolment (M1), after balloon deflation (M2), 6-8 h after M2 (M3) and at discharge (M4). Total antioxidant capacity of plasma (ferric reducing ability of plasma - FRAP), erythrocyte reduced glutathione (GSH) and plasma ascorbate levels were determined in blood samples. Cardiac magnetic resonance (CMR) was performed at 7-15 days and 2-3 months following PCA. Ninety-nine patients were enrolled. In 67 patients, the first CMR was performed, and 40 patients completed follow-up. RESULTS The ascorbate group showed significantly higher ascorbate and FRAP levels and a decrease in the GSH levels at M2 and M3 (p < 0.05). There were no significant differences in the infarct size, indexed end-systolic volume and ejection fraction at both CMRs. There was a significant amelioration in the decreased ejection fraction between the first and second CMR in the ascorbate group (p < 0.05). CONCLUSIONS Ascorbate given prior to reperfusion did not show a significant difference in infarct size or ejection fraction. However, it improved the change in ejection fraction determined between 7-15 days and 2-3 months. This result hints at a possible functional effect of ascorbate to ameliorate MRI.
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Affiliation(s)
| | - Roberto Brito
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Jaime González-Montero
- Faculty of Medicine, University of Chile, Santiago, Chile
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Nicolás Valls
- Faculty of Medicine, University of Chile, Santiago, Chile
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Juan G. Gormaz
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Juan C. Prieto
- Faculty of Medicine, University of Chile, Santiago, Chile
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | | | | | | | | | - Ramón Rodrigo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
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Valls N, Gormaz JG, Aguayo R, González J, Brito R, Hasson D, Libuy M, Ramos C, Carrasco R, Prieto JC, Dussaillant G, Puentes Á, Noriega V, Rodrigo R. Amelioration of persistent left ventricular function impairment through increased plasma ascorbate levels following myocardial infarction. Redox Rep 2016; 21:75-83. [PMID: 26066587 DOI: 10.1179/1351000215y.0000000018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Percutaneous coronary angioplasty (PCA) has been demonstrated to reduce mortality and morbidity and thereby improve the prognosis of patients undergoing acute myocardial infarctions (AMIs). However, this procedure paradoxically increases the initial damage as the result of a condition known as 'myocardial reperfusion injury'. Oxidative stress may contribute to the mechanism of this injury. The goal of the present study was to ascertain whether high plasma ascorbate levels could ameliorate the reperfusion injuries that occur after the successful restoration of blood flow. METHODS Patients from three clinical centers of the public health system were included in the study. The groups were formed by either-sex patients with a diagnosis of ST-segment elevation myocardial infarction with an indication for primary PCA. Only the patients who presented with their first myocardial infarction were enrolled. Ascorbate was administered through an infusion given prior to the restoration of the coronary flow, which was then followed by oral treatment with vitamin C (500 mg/12 hours) plus vitamin E (400 IU/day) for 84 days. The left ventricular ejection fraction (LVEF) was determined by using cardiac magnetic resonance on days 6 and 84 following the onset of the reperfusion. In addition, the microvascular function was assessed by an angiographic evaluation using the Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade (TMPG). The results were grouped according to the plasma ascorbate concentration achieved immediately following the onset of reperfusion into either the HA group (high ascorbate, >1 mmol/l) or the LA group (low ascorbate, <1 mmol/l). The biochemical parameters were analyzed throughout the protocol. RESULTS The LVEF of the HA group was significantly higher than that of the LA group, values on day 84 in the HA group were 33% higher than those of the LA group. The amelioration of the LVEF was accompanied by an improvement in the microvascular dysfunction, after PCA, 95% of the patients in the HA group achieved a TMPG of 2-3, in the LA group only 79% of patients showed a TMPG of 2-3. CONCLUSIONS These data are consistent with the protective effect of high plasma levels of ascorbate against the oxidative challenge caused by reperfusion injury in patients subjected to PCA following an AMI. Further studies are needed to elucidate the mechanism accounting for this beneficial antioxidant effect.
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Affiliation(s)
- Nicolás Valls
- a Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile , Santiago , Chile
| | - Juan G Gormaz
- a Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile , Santiago , Chile
| | - Rubén Aguayo
- b Cardiovascular Department , San Juan de Dios Hospital , Santiago , Chile
| | - Jaime González
- a Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile , Santiago , Chile
| | - Roberto Brito
- a Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile , Santiago , Chile
| | - Daniel Hasson
- a Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile , Santiago , Chile
| | - Matías Libuy
- a Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile , Santiago , Chile
| | - Cristóbal Ramos
- c Department of Radiology , University of Chile Clinical Hospital , Santiago , Chile
| | - Rodrigo Carrasco
- a Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile , Santiago , Chile
| | - Juan C Prieto
- a Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile , Santiago , Chile.,d Cardiovascular Department , University of Chile Clinical Hospital , Santiago , Chile
| | - Gastón Dussaillant
- d Cardiovascular Department , University of Chile Clinical Hospital , Santiago , Chile
| | - Ángel Puentes
- b Cardiovascular Department , San Juan de Dios Hospital , Santiago , Chile
| | - Viviana Noriega
- a Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile , Santiago , Chile
| | - Ramón Rodrigo
- a Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile , Santiago , Chile
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